Application Of Preperitoneal Pelvic Packing In The Treatment Of Hemodynamically Unstable Pelvic Fractures

Objectvie: Pelvic fracture is a serious trauma,accounting for 1% to 3% of the total number of fractures.It is mostly caused by high-energy trauma.More than half are accompanied by comorbidities or multiple injuries,and the disability rate is as high as50% to 60%.The most serious is traumatic hemorrhagic shock and combined injury of pelvic organs.Improper treatment has a high mortality rate of 10.2%.At present,there are few studies on preperitoneal pelvic packing in hemodynamically unstable pelvic fractures.In this study,we reviewed the clinical data of 89 patients with t the hemodynamically unstable pelvis and analyzed the preperitoneal pelvic cavity.The role of packing is to be studied to clarify the therapeutic effect of the operation.Methods: This retrospective study collected clinical data of patients with hemodynamically unstable pelvic fractures admitted to the emergency center of our hospital from October 2015 to September 2020 from the medical record system.A total of 89 cases were analyzed in this study,including 54 males and 35 females,ranging in age from 25 to 88 years old.All patients were injured due to pelvic fractures caused by high-energy injuries.All patients underwent external pelvic fixation.According to whether preperitoneal pelvic packing was performed,the patients were divided into external fixation group and external fixation + packing group.The two group’s baseline conditions,injury causes,fracture types,vital signs,laboratory results,blood transfusion,ICU hospitalization days,and deaths were compared.Results: In this study,we observed that the improvement of SBP,heart rate,and lactic acid in the external fixation + packing group was better than that of the external fixation group.There was no significant statistical difference between the two groups in the comparison of hematocrit.The amount of blood transfusion in the external fixation + packing group was significantly less than that in the external fixation group.Patients in the external fixation + packing group spent less time in the ICU than those in the external fixation group.In the external fixation group,5 patients died during hospitalization;in the external fixation + packing group,3 patients died during hospitalization.This study shows that after preperitoneal pelvic packing,the patient’s hemodynamics is stable.The situation is significantly improved compared with patients who have not undergone packing.The improvement in hemodynamics described above may be attributed to the effective control of acute venous bleeding and the reduction of the overall potential space required to pack pelvic bleeding.However,the hematocrit did not increase significantly,and it was slightly lower than before the operation.The reason may be that the patient is still in the recovery period after pelvic packing,and the hematocrit level has not been completely reversed.Conclusion: The technique of preperitoneal pelvic packing is simple and easy to implement,and it is suitable for patients with different severity of hemodynamic instability.It can be considered to routinely apply preperitoneal pelvic packing to patients with hemodynamically unstable pelvic fractures.